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The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
The trend to swap electronic health records has been gaining momentum in recent years. A 2014 KLAS report surveyed 277 large US hospitals, half of which indicated plans to replace their current EHR system by 2016. That number marks a significant wide-scale investment, since the cost of an EHR implementation may range from millions of dollars for a standalone hospital to hundreds of millions for a regional health system, according to a Becker’s Healthcare article. Organizations are increasingly swapping systems to gain needed functionality, achieve interoperability, leverage analytics and more. As the EHR market continues to consolidate, this development begs the question: are organizations ever fully adopting their EHR systems and overcoming problems uncovered during the initial go-live?

A new survey may provide insights. The American Academy of Family Physicians (AAFP) surveyed 305 physicians to uncover the challenges and outcomes associated with EHR-to-EHR transitions. While 59 percent agreed their new EHR provided useful functionality, only 39 percent reported being satisfied after transitioning. In fact, 49 percent disagreed that their new system improved productivity, and 41 percent considered their new EHR overly complex to use. These numbers suggest that changing applications does not always improve outcomes related to the EHR, especially since a majority of respondents had been using the application for a year or more.

The challenges being reported around EHR transitions are similar to those we have observed for years when the EHR isn’t fully adopted. Research published in Beyond Implementation: A Prescription for Lasting EMR Adoption identified how often organizations overestimate their adoption of an EHR system, a factor that can have significant consequences as organizations transition between applications. These organizations are likely to overlook problems impeding adoption and underestimate the resources and focus needed for the new system. Disengaged leaders, poor education, inadequate end-user support—all are inevitable if unresolved in the original system. The result is a continuation of an organization’s current headaches—from poor usability, to decreased productivity, to end-user dissatisfaction.

There are other potential pitfalls in transitioning EHR systems. For instance, leaders tend to underestimate the need for strong communication, physician alignment, and governance for upcoming changes. While they may have focused on these areas during their initial implementation, they may perceive them as unnecessary for the new system, a decision that puts adoption at risk over the long-term. Organizations should expect the EHR-to-EHR transition to bring the same, if not more significant, challenges as their original implementation.

Organizations may also struggle to anticipate end-user resistance to the new system, which is greater than the switch from paper. While end users may be dissatisfied with the current system, they are often not willing to face the challenge of learning a new system, requiring them to relearn the workflows and keyboard shortcuts they worked so hard to learn. Additionally, end users might question the value of an electronic-to-electronic switch. This is especially true when the transition is due to a merger or acquisition, as shown by the AAFP survey.

Organizations must rely on the tried-and-true methods to achieve EHR adoption, whether moving off paper or an existing electronic system. Beginning with leadership engagement, organizations must communicate, ensure physician alignment, and create governance to ensure accountability and ownership of the new system. End users should receive consistent and effective education. Education is most effective when it is scenario-based, repeatable, readily-accessible, and provides hands-on experience completing workflows in the EHR system. To understand the education and support needs of end users, organizations must track and measure performance. And lastly, they must sustain adoption efforts over time to ensure they remain relevant despite application upgrades and workflow improvements.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As long as I’ve been blogging, I’ve been quite interested in the various EHR selection tools that are available out there. For a while, it seems like there was a new EHR selection tool coming out every week. The frenzy of EHR selection tools has mostly stopped and only a few major ones remain. One of those is EHR consultant (Full Disclosure: Has been an advertiser on EMR and HIPAA for many years) which has been doing this as long as anyone and has one of the most comprehensive EHR databases out there. The other that has lasted all this time is EHR Selector. Then, to round out the various EHR selection websites, there are the websites out there like Medical Software Advice and even the AAFP offers a tool to help in EHR selection (only available for AAFP members).

As I suggest in my e-Book on EMR selection, I think you should take advantage of multiple EHR selection tools. I call it triangulating the data since none of them are comprehensive with the EHR world changing so quickly. So, you take all of the data and triangulate down to the best EHR possible.

Many might wonder why I’m talking about EHR selection anyway. Well, if you’re being generous, we’re somewhere around 50% EHR adoption. That’s still a lot of doctors who haven’t adopted EHR. Add to that the number of clinics that are looking to switch EHR software, and there’s still a big need for great EHR selection tools.

The reason I started this look at EHR selection websites is because EHR Selector has rolled out an Open Beta with new features. The best feature they’ve rolled out is that EHR selector is now free for everyone to use. I was pretty harsh on EHR selector in the past for charging doctors to use their service. That business model just didn’t make sense to me. Ironically, Carl Bergman (one of the people behind EHR Selector), has since become a regular reader of this site and we regularly exchange emails about the EHR world. So, I’m glad that he converted the service to a free service for everyone to use.

I tried out the new release of EHR selector and I have some mixed reviews. It is a beta release so that’s partially to be expected. I was a bit overwhelmed by the number of fields I had to complete to get into the tool. I imagine that could be streamlined some to make it a better experience for the user. Although, I expect the data is part of the reason the service can be made free. Plus, the more data you offer, the better customized experience the EHR selection tool can offer you.

What I do love about EHR Selector is that it’s always had a deep set of data available. I wonder if this will backfire for some users thanks to the paradox of choice. Although, as a data lover I really love all the data. Plus, they could help solve this issue with how they choose to display the various EHR and their data with a beautiful UI. I don’t think the UI is to that point yet, but having the data is the first step in that process.

My favorite feature of EHR Selector is the Compare EHR feature. I love seeing the features of multiple EHR’s compared side by side. This is where all the EHR data points becomes really valuable as well. One thing I do wish is there was more than just a check mark for each EHR data point. I’d love to have some qualitative description or images of each data point so you could really compare the EHR features that matter most to you.

One of the other shortcomings of EHR Selector is they haven’t yet gotten the data for all 300+ EHR vendors. No doubt that’s a daunting task and you have to start somewhere. I expect they’ll work to resolve this over time. Plus, they need the support of the EHR vendors to be able to get the data as well (not always an easy task).

Certainly EHR Selector isn’t perfect yet, but with its new Free feature it’s worth taking a look at if you’re in the market for an EHR. It’s another nice data point in the EHR selection process.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week when I was at the AAFP conference in Denver, I had a doctor say “Will an EMR system help me to provide better patient care than my current paper charts?”

I’ll save his personal feeling and my thoughts on the question for a follow up post later this week. For now, I’ll leave it open for discussion in the comments. I think this will be a lively comment section. I’ll preview my answer by saying that I think the question is partially framed the wrong way.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I knew that my previous post about the cost to update an EMR would bring out the people who like to back the SaaS EMR model versus those who like to back the Client Server EMR. As I’ve said before, it’s one of the most heated debates you can have in the EMR space.

I realized in the comments of that post why it’s such a heated topic. It’s because once an EMR software chooses to go down one path or the other, it’s nearly impossible to be able to switch paths. Why? Cause if you do choose to switch you basically have to just code a new application all over. Basically, the switching costs are enormous. So, only a few software companies (let alone EMR software companies) ever change from one to the other.

Considering the high switching costs, that basically means that an EMR vendor that is SaaS based has a strong vested interest in the benefits and upside of the SaaS model of software development. The same is true for Client Server EMR software and client server EMR companies looking at the benefits and upside of the client server model of software development.

This entrenching around a software development methodology (for which they can’t change) is what makes discussing each model so interesting. Each party dutifully makes the most of whichever software development methodology they’ve been given.

Of course, from the clinical perspective it’s sometimes hard to cut through all this discussion and get good information on the real pros and cons of each model.

In that vein, I’m looking for a couple EMR and HIPAA readers that would be interested in making the case for one or the other. All you’d need to do is create a guest blog post on the pros and cons of your preferred method. If needed, you’d also be welcome to do a response post to the other method’s post as well.

If this interests you, leave a comment or let me know on my Contact Us page. I think this could be really interesting.

On a different note, it looks like I’m going to be attending the AAFP conference in Denver next week. Is anyone else planning to be there? Anything I should know about the conference to get the most out of it?

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yes, you might have noticed that I’m going back through a lot of the old articles that I should have posted about previously and never did. This was a real good find from an article written back in 2002. 7 years ago and this information still rings true. The article is for the AAFP and is called “Why I Love My EMR” by William D. Soper, MD, MBA. He gives these common excuses for not implementing an EMR:

An EMR is too expensive

I don’t need an EMR to be a good doctor

Is it safe to keep my records on a computer?

What if the electricity goes off?

What about patient confidentiality?

What about HIPAA?

Where do I find time to learn a new system?

How can I convince doctors who are dragging their feet?

How do I find time to see patients and enter my own data?

What do I do with my old records?

How do I decide which system to buy?

Won’t technology improve and prices go down?

Then, he ends with his bottom line:

What’s the bottom line?
EMRs aren’t for everyone. Going digital is costly. The conversion process isn’t easy, and acquiring new skills is frustrating, hard work. However, I’ve found that transitioning to an EMR system has been worth every frustration and every penny. It has made me a better doctor, reduced my overhead, made my staff happy and pleased my patients. I can’t convince you to let go of your paper records. That’s for you to decide. But I am willing to bet that if you do, you’ll get the same results I did.

Any of the above excuses/questions look familiar to any of you? Seems like the answers to these questions might be a good basis for a book.

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